Mesenchymal Stem Cell-derived Exosomes in Multicellular Regulation and Retinal Homeostasis Maintenance

Retinal degenerative diseases like AMD and DR lead to irreversible vision loss through disrupted homeostasis. Mesenchymal Stem Cell-derived Exosomes (MSC-Exo), as a cell-free therapy, demonstrate significant potential in restoring retinal balance via multi-target regulation. This review elucidates the protective effects of MSC-Exo on key retinal cells, including pigment epithelium, endothelial cells, Müller glia, microglia, and ganglion cells, and specifically examines its role in modulating shared cellular pathways such as PI3K/AKT-Nrf2. It highlights a therapeutic cascade from vascular repair and anti-inflammation to neuroprotection, which coordinates intercellular interactions and promotes holistic retinal recovery. Finally, the review discusses the challenges and future clinical prospects of MSC-Exo-based therapies.